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Individual

BERENICE DE LA CRUZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., BCBA

Contact information

Practice address
11712 DUNBLANE WAY, AUSTIN, TX 78754-5870
(512) 299-4456
(512) 472-5787
Mailing address
11712 DUNBLANE WAY, AUSTIN, TX 78754-5870
(512) 299-4456
(512) 472-5787

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1062804

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
260560776
FEDERAL ID #
Enumeration date
09/11/2007
Last updated
09/11/2007
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